Hamilton Scale Research Articles

Depressive state associated with cryptogenic rigid person syndrome (case study)

The article describes peculiarities of modern understanding of the nature and treatment of the rigid person syndrome. Baclofen, a GABA-B agonist, is one of the drugs of choice for the treatment of this condition. However, its oral use has little efficacy and leads to a number of complications. An indisputable alternative to oral administration of the drug at present is its continuous intrathecal administration using an implantable pump. A case of cryptogenic rigidity syndrome accompanied by the development of a depressive state is presented. In the process of treatment by intrathecal baclofen therapy, not only excruciating muscle spasms disappeared, but also depressive symptomatology without special use of antidepressants.The purpose of the study. To show the high effectiveness of ITT in a patient with a severe cryptogenic form of CRS, as well as the effect of OT, not only on spasticity, but also on depressive symptoms.Material and methods. A case of treatment by the ITB method with implantation of a pump to a patient with a cryptogenic form of HPV is presented. A modified Ashworth scale (MAS) was used to assess spasticity. The patient’s quality of life was assessed on the Barthel scale. The Hamilton scale was used to assess the level of depression.

Decreased Systemic Monocyte Colony Protein-1 (MCP-1) Levels and Reduced sCD14 Levels in Curcumin-Treated Patients with Moderate Anxiety: A Pilot Study.

Psychosocial stress may alter cortisol and/or affect the normal functioning of the immune system. Curcuminoids can promote beneficial effects in neuropsychiatric diseases. We evaluated whether curcumin supplementation for 15 consecutive days (1800 mg/day) would decrease systemic MCP-1, sCD14, and TNF alpha levels in patients with moderate anxiety (n = 81). A total number of 81 subjects were enrolled in this study, divided into the following groups according to their Hamilton scores: a control group including patients without anxiety who were not taking curcumin (Cont, n = 22) and an anxiety group including patients with moderate anxiety (Anx, n = 22). The curcumin-treated patients experienced moderate anxiety, and they take curcumin for 15 consecutive days (Anx-Cur (after), n = 15, 1800 mg/day). An evaluation of 128 patients was conducted, which allowed for their assignment to the study groups according to their scores on Hamilton scale II. The cortisol levels were quantified in salivary samples through ELISA (ng/mL), and malonaldehyde (MDA) levels were measured in plasma via the TBARS assay as an index of lipoperoxidation. Several systemic proinflammatory cytokines (pg/mL: MCP-1, TNF alpha, IL-1 beta) and mediators were quantified through ELISA (pg/mL), including systemic sCD14 levels as a marker of monocyte activation. A two-way bifactorial ANOVA was conducted to evaluate the contributions of the anxiety factor (Anx) and/or curcumin factor (Cur) in all the tested markers, including interactions between both factors. High systemic MCP-1 and elevated sCD14 levels were observed in patients with moderate anxiety, which were reduced with curcumin supplementation. In addition, curcumin prevented cortisol overexpression and decreased MDA levels as an antioxidant response in these patients. Collectively, curcumin presented anti-chemotactic effects by reducing systemic MCP-1 levels in anxiety. Curcumin decreased systemic MCP-1 as well as sCD14 levels in patients with moderate anxiety.

A cross sectional study evaluating the relationship of acne to androgenetic alopecia subtype and severity.

The circulating androgens have a role in the pathogenesis of both acne vulgaris and androgenetic alopecia; an association between these two have been found previously. The aim of this study is to investigate the relationship of the severity of acne vulgaris lesions to the subtype of AGA; and to validate the relationship between severities of acne vulgaris and AGA. This study was conducted cross-sectionally at five different dermatology clinics. Male and female androgenetic alopecia patients with comorbid acne vulgaris have been included. The age, gender, severity of acne lesions, subtype of androgenetic alopecia and the severity of androgenetic alopecia were noted. The severity of acne lesions were graded according to the Global Acne Severity Scale and androgenetic alopecia was graded according to the Hamilton and Ludwig Scales. SPSS v 21 was used for the statistical analysis. A total of 101 patients have been included (12 male and 89 female). The mean age of the patients with severe acne was statistically significantly lower (p = 0.020). The difference in terms of gender was statistically insignificant (p = 0.388). The severity of acne vulgaris was found to be independent of the severity and of the subtype of AGA; p = 0.623 and 0.870 respectively. Neither a relationship between the severity of androgenetic alopecia and severity of acne; nor a relationship between acne severity and androgenetic alopecia subtype were found in this study. Thus we report that, acne severity is independent of the subtype and stage of the co-existing androgenetic alopecia.

Anxiety, depression, and perceived stress among loco pilots of Indian Railways.

The job of loco pilots of Indian Railways is very demanding as they are responsible for operating locomotives and ensuring the safe and timely transportation of people and goods across the vast and diverse landscape of the country. So, they are prone to various mental health issues. To study anxiety, depression, and perceived stress among loco pilots of Indian Railways and to study their correlation with various work-related factors. This cross-sectional study included 53 loco pilots recruited by convenience sampling from three railway stations under the Kota Division of Indian Railways. Prior permission from the Institutional Ethical Committee was taken. After obtaining informed consent, loco pilots were evaluated on Hamilton scales for Anxiety and Depression and Perceived stress scale 10. The mean age of participants was 32.01 ± 6.15 years. They were working for an average of 61.01 ± 19.12 hours per week. The majority of them were assistant loco pilots and were operating goods trains. 26.41%, 20.76%, and 13.20% had mild, moderate, and severe anxiety, respectively. Likewise, 30.19% and 5.66% had mild and moderate depression, respectively. Also, 33.97%, 50.94%, and 15.09% of loco pilots had low, moderate, and high perceived stress, respectively. Age, working hours, and years of work experience did not correlate significantly with anxiety and depression scores. A significant positive correlation of perceived stress score was found with average working hours per week (P = 0.012). The magnitude of psychiatric problems among loco pilots was found to be significant and hence needed to be addressed. Also, further exploration of factors contributing to these mental health issues is required.

Features of the course of the disease, quality of life and cytokine profile in patients with psoriasis vulgaris in the stationary stage and comorbid depression

Aim. To study the characteristics of the course of the disease, quality of life and cytokine profile in patients with psoriasis vulgaris in the stationary stage and depression.Material and methods. A prospective, cross-sectional comparative study involved 154 patients with vulgar psoriasis in the stationary stage; Of these, two groups were formed: 83 patients with comorbid depression and 71 without comorbid depression. The Hamilton scale was used to determine depressive symptoms and severity.Result. Patients with psoriasis vulgaris in the stationary stage and depression were characterized by a younger age (p=0.007), a more severe course of the disease according to the PASI index (p<0.001), visual analogue scale (p=0.014), and a higher frequency of relapses (p=0.012) and a lower level of quality of life according to the DLQI questionnaire (p<0.001), as well as higher values of IL-6 and IL-17 in the blood serum (p=0.011; p=0.001, respectively). An inverse correlation was established between the average total value on the Hamilton scale and the age of the patients (r= –0.61; p=0.002), a direct one – with the average total values on the PASI index (r=0.72; p=0.001), visually analogue scale (r=0.63; p<0.001), DLQI (r=0.69; p=0.001) and IL-17 (r=0.62; p=0.012).Conclusion. In patients with depression, psoriasis vulgaris in the stationary stage is more severe, accompanied by an increase in systemic proinflammatory changes and a more significant decrease in quality of life than in patients without depression. The results obtained must be taken into account when choosing a therapeutic strategy for psoriasis vulgaris, which will personalize treatment and increase its effectiveness.

Синдром Алажиля в клінічній практиці дитячого хірурга

Alagille syndrome (AGS) is one of the most problematic for the diagnosis of hereditary, multisystem, cholestatic liver diseases in combination with other congenital defects. Timely diagnosis and treatment (including liver transplantation - LT) improves the quality of life (QoL), prevents irreversible liver changes, multiple organ failure and mortality. Aim – to study the possibilities and features of the differential diagnosis of AGS, the impact of complex treatment, surgical correction (including LT) on the course of the disease, the dynamics of clinical and laboratory indicators, physical development (FD) and neuropsychological development (NPD), QoL. Materials and methods. Verification of the diagnosis of AGS included clinical, biochemical, instrumental examinations, genetic markers of AGS. Quality of life was evaluated: assessment of skin itching (on a categorical scale, according to the visual analogue scale of pruritus; the level of anxiety was determined according to the Hamilton scale (modified). FD and NPD were evaluated by pediatricians and pediatric neurologists before and after treatment. The assessment of FD according to centile tables was carried out in accordance with WHO standards. The assessment of NPD was carried out: development delay for one, two, three epicrisis terms; degree of NPD delay. Results. Against the background of treatment, biochemical and clinical indicators improved. Itching of the skin (according to the categorical scale of itching, visual analogue scale of pruritus), decreased the anxiety index. The dynamics of the FD and NPD were positive. Conclusions. Modern possibilities of diagnosis of AGS include genetic and histological methods, which makes it possible to start pathogenetic therapy early, to decide the time and ways of surgical intervention (including LT). The presence of concomitant congenital defects of other organs and systems, the characteristic appearance of children with AGS require a multidisciplinary examination with the involvement of multidisciplinary specialists. Complex and timely treatment of AGS contributes to the normalization of clinical and biochemical indicators, FD, NPD, quality of life. Radical treatment of AGS by means of LT should be considered before the period of irreversible multiorgan changes, taking into account the preservation of FD and NPD. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research. The author declares no conflict of interest.

Опыт лечения депрессивных расстройств вортиоксетином после гистерэктомии

Relevance. Antidepressants are widely used in clinical practice for neurological disorders. Vortioxetine refers to the latest generation of drugs, the appointment of which is appropriate for depressed patients after hysterectomy. Objective: to evaluate the effectiveness of vortioxetine in combination with menopausal hormone therapy in correcting depressive symptoms after hysterectomy. Materials and methods. 136 patients with depressive disorder after hysterectomy (average age 44.7±1.3 years) were examined and treated, who were divided into two groups. The main group consisted of 74 (54.4%) patients who were prescribed divigel with vortioxetine in combination. The control group included 62 (45.6%) patients who used only divigel. All underwent clinical and laboratory monitoring, psychological assessment on the Hamilton Depression scale (HDRS-21). Results. In the main group according to the Hamilton scale (HDRS-21), 26 (35.1%) patients showed mild depression, 48 (64.9%) moderate depression, in the control group 20 (32.2%) and 42 (67.8%) respectively. Against the background of complex therapy, a decrease in the indicators of the mental and somatic component was revealed. After a month, 16 (21.7%) patients of the main and 22 (35.4%) of the control group complained of depression, depression, a sense of self-worth, 21 (28.3%) and 27 (43.5%) of guilt, 9 (12.1%) and 11 (17.8%) slow thinking, 25 (33.8%) and 29 (46.8%), respectively, for a decrease in motor activity. Before the start of treatment, 49 (66.2%) patients of the main and 40 (64.5%) control groups complained of headache of varying intensity, 11 (14.9%) and 8 (13.0%) of pain in the lumbar region, 17 (23.0%) and 15 (24.1%), respectively, of body aches and soreness in small joints. During the first month of treatment, pain in the lumbar region decreased, followed by headaches, and soreness in the body and joints lasted longer. Conclusions. Against the background of taking an antidepressant in the examined patients, positive dynamics of the disease was noted, both in the subjective assessment of the condition and in the objective result of psychological symptoms. Vortioxetine, which has high clinical efficacy and good tolerability, can be recommended in the treatment of depression after hysterectomy.

Use of vortioxetine in treating obsessive-compulsive disorder: a case report

Introduction Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.ObjectivesTo evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.MethodsClomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.ResultsThe dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.The pre and post results are summarized in tables 1 and 2. Table 1.Hamilton Depresion Rating Scale (0-52)BasalPost 10-week treatment214Dimensional Y-BOCS (0-15)BasalPost 10-week treatmentAggressive-related obsessions and compulsions102Religious-related obsessions and compulsions51Symmetry and order71Pollution and cleaning00Collecting and accumulation20Miscellaneous103ConclusionsVortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.Disclosure of InterestNone Declared

Depression, Anxiety, and Burnout, Their Association with Academic Dropout Ideation in Medical Residents

Objective: to analyze the association between depression, anxiety, and burnout with the risk of academic desertion, and ideation of academic desertion in medical residents. Methods: Cross-sectional study with a sample of 200 medical residents in Mexico City. Maslach, Beck, and Hamilton scales were used to assess burnout, depression, and anxiety, respectively. The main variable was academic desertion. Statistical analysis included descriptive and inferential methods; risk was assessed by odds ratio (OR). Multivariate models were used to explore associations, with statistical significance considered at p <0.05. Results: The frequency of depression, anxiety, and burnout was 17% (n= 34), 26.5% (n= 53), and 19.5% (n= 39), respectively. The presence of depression was associated with up to a fourfold and sixfold increase in desertion and desertion ideation, respectively (OR= 4.04, 95% CI 1.41 - 11.5, p= 0.006, or 6.5, 95% CI 2.9 - 14.6, p= 0.000). Anxiety showed no association with turnover (OR= 1.02, 95% ci 0.26 - 4.01, p= 0.967). The presence of burnout doubled the risk (OR= 2.2, 95% CI 1.07 - 4.52, p= 0.001). In the multiple analysis, depression increased the risk of dropping out up to fourfold. Conclusion: The presence of depression was the disorder most associated with dropout and dropout ideation. It is necessary to establish prevention, and detection programs at medical residency sites.

Suicide ideation and male-female differences in major depressive disorder

Objective This study aimed to explore male-female differences in suicide ideation (SI) and suicide risk factors in major depressive disorder (MDD). Methods We analysed 482 adults (sample 1) and 438 elderly outpatients (sample 2) with MDD. Sample 1 was treated with different antidepressant combinations (escitalopram; bupropion plus escitalopram; venlafaxine plus mirtazapine) and assessed by means of the Concise Health Risk Tracking (SI), Quick Inventory of Depressive Symptomatology, Altman Mania Rating Scale and Psychiatric Diagnostic Screening Questionnaire. Sample 2 was treated with venlafaxine and assessed using the Hamilton scale for depression, Anxiety Sensitivity Index and Penn State Worry Questionnaire for anxiety, Beck Scale for Suicide Ideation and Repeatable Battery for the Assessment of Neuropsychological Status. Results In sample 1, females had greater depression severity (O.R 0.961 99%CI: 0.929 − 0.995), males reported more alcohol abuse (O.R 1.299 99%CI: 1.118 − 1.509) and active SI (O.R 1.109 99%CI: 1.005 − 1.255). In sample 2 men showed more severe SI (O.R 1.067; 99%CI: 1.014 − 1.122) and weight loss (OR = 5.89 99%CI: 1.01 − 34.19), women more gastrointestinal symptoms. Conclusions In these selected samples, although women had more severe depression, men had more suicide risk factors. Such differences might contribute to men’s increased suicide risk.

Нарушения сердечного ритма и профиль артериального давления у пациентов с боевыми травмами

Aim. To investigate possible rhythm and conduction disturbances, as well as the blood pressure (BP) profile in young and middle-aged patients with combat wounds. Materials and methods. The cross-sectional study enrolled 102 patients who suffered limb injuries in the period from 13 to 114 days (median 38 days) before admission to the hospital. The age of the patients included in the study ranged from 20 to 59 years, with an average of 35.7±8.5 years. Patients underwent Holter ECG monitoring and 24-hour BP monitoring. The following questionnaires and scales were used: a questionnaire to identify signs of autonomic changes (A. Vein), a scale for assessing the severity of psychophysiological response to stress, an insomnia severity index, the Hamilton scale for assessing anxiety, the Hamilton scale for assessing depression, a questionnaire for PTSD screening, visual analog pain scale. Results. The mean heart rate per day reached 84.6±11.1 per minute, the minimum heart rate was 56.9±10.1, the maximum heart rate was 134.4±18.6 per minute. The group mean duration of tachycardia was 498.1±316 minutes (8 hours 18 minutes). There was an inverse correlation between the age of patients and the duration of tachycardia per day (r=-0.29; p=0.04), maximum heart rate (r=-0.28; p=0.007), minimum heart rate per day (r=-0.23; p=0.02). In patients 20-29 years old, the maximum heart rate reached 141.4±19.4, in patients over 40 years old – 134.3±17.9 (p=0.009). The mean value of the circadian index for the group was 1.17±0.13 (0.68-1.47). In 69.7%, the circadian index was rigid. Heart rate variability was within normal values in 32.2% of the examined patients, in 48.8% it was reduced, and in 19.1% it was sharply reduced. Heart rhythm disturbances were recorded in 65.5% of patients. The most frequently detected sinus arrhythmia (in 76.2% of cases of all arrhythmias), migration of the supraventricular pacemaker (in 27.0%) and atrial rhythm (in 11.1%). Arterial hypertension was detected in 67.7% of the examined patients. The maximum systolic BP (SBP) corresponding to arterial hypertension of the 1st degree was registered in 43.9% of patients, grade 2 – in 19.7%, grade 3 – in 3.0%, high normal BP – in 16.7%, normal BP – in 16.7%. Maximum diastolic BP (DBP) corresponding to grade 1 hypertension was found in 30.8% of patients, grade 2 – in 30.8%, grade 3 – in 15.4%, high normal BP – in 10.8%, normal BP – in 12.3%. The mean daily SBP was 126 mm Hg, DBP was 81 mm Hg. The mean daytime SBP was 128 mm Hg, DBP was 82 mm Hg. The mean nighttime SBP is 118 mm Hg, DBP is 77 mm Hg. The maximum SBP was 148 mm Hg, DBP was 97 mm Hg. When analyzing the types of daily BP curves, the vast majority of patients (44.6%) were classified as “non-dipper” type, both for SBP and DBP. Conclusions. The study results indicate that patients with combat injuries very often have sinus tachycardia, which is recorded over a long period of time. Heart rate is highest in the youngest injured patients and decreases as age increases. Sinus arrhythmia is very common, other rhythm and conduction disorders are much less common. High BP, especially DBP, is often recorded.

Effects of a home care community-dwelling intervention on cognition, mental health, loneliness and quality of life in elder people: The VERA study

BackgroundNew technologies can provide practical solutions that respond to the needs of the elderly, improving their quality of life and well-being. The aim of this research was to validate a multimodal approach based on a video call system, by comparing the scores of different clinically validated tests at baseline and at the end of the intervention. MethodsA longitudinal study was conducted with 7 healthy participants aged 61 to 92 years over a 6-month period. To measure the effectiveness of the intervention, five variables were assessed: cognitive impairment, quality of life, general health, perceived loneliness, and depression. The following inventories were used as instruments to measure the aforementioned variables at baseline, mid intervention and after intervention: MEC-35 scale, Fototest, FUMAT scale, WHOQOL-BREF scale, Yesavage Geriatric Depression Scale, the Spanish adaptation of the Hamilton Scale, the revised ESTE scale and the Goldberg's GHQ28 Mental Health scale. ResultThe obtained results confirmed our hypothesis and the participants showed significant improvements after intervention in all the assessed domains except the cognitive domain, as expected. Results in FUMAT, WHOQOL-BREF, Yesavage Geriatric Depression, revised ESTE and the Goldberg's GHQ28 Mental Health scales were statistically significant (p < 0.05) and the effect sizes were large after intervention compare to baseline. ConclusionsWe have shown that the intervention has been effective in providing the participants with psychological and social benefits in the variables of quality of life, general health, perceived loneliness and depression. The high clinical relevance achieved from the results obtained makes the system a very suitable tool to promote the independence and well-being of people who receive community-dwelling home care.

Spiritual emotional freedom technique and level anxiety among people with pre-percutaneous coronary intervention

Introductions: Percutaneous Coronary Intervention is a low-risk diagnostic procedure, but many patients experience a high level of anxiety. Objectives: The purpose of the study was to determine the effect of SEFT on the anxiety level among people with Pre- Percutaneous Coronary Intervention. Methods: The research design used a quasi-experiment with a pretest-posttest design with a control group design. The number of samples used G-Power with nonprobability sampling was as many as 18 people in each group (a total of 36 people). The inclusion criteria are elective inpatients, patients diagnosed with CAD who have anxiety and are able to communicate, patients indicated as primary care, and patients with complications and panic are excluded, SEFT consists of set-up, tune-in, and tapping given one hour before cardiac catheterization for 15–25 minutes with two repetitions. Questionnaires for measuring anxiety levels before and after therapy using the Hamilton Scale for Anxiety (HARS) with validity (r count 0.57–0.97) and reliability (0.93–0.97). The analysis used Mann-Whitney. Results: The short version of SEFT in the control group (p-value 0.001) and the long version of SEFT in the intervention group (p-value &lt;0.001) were proven to have an effect on reducing anxiety scores. there was no difference in the mean anxiety scores between the groups given the long version and the short version of the SEFT intervention (p-value 0,053). Conclusion: The conclusion of the study showed the effect of SEFT therapy on the anxiety of cardiac pre-catheterization patients. SEFT can be a complementary nursing therapy to reduce anxiety.

Psychological status of women with miscarriage

Introduction. During pregnancy, a woman becomes vulnerable to develop symptoms of depression and anxiety, which in turn are associated with increased risk of perinatal complications, postpartum depression as well as behavioral problems in children.Aim: to assess the prevalence of symptoms related to depression and anxiety in pregnant women with threatened abortion (ТА), non-developing pregnancy (NP) as well as those with physiological course of pregnancy (РР) in the first trimester of pregnancy; to reveal major predictors of psycho-emotional disorders in pregnant women.Materials and Methods. Three groups of pregnant women were stratified: 62 patients with TA, 60 patients with NP and 57 women with PP. Clinical history and physical examination were performed in all subjects. All pregnant women were assessed by Hamilton Anxiety Rating Scale and the Beck Depression Inventory.Results. It was found that the mean Beck’s score was significantly higher in NP vs. TA and PP groups (p &lt; 0.05). Moreover, significant differences were also observed while comparing TA and PP groups (p = 0.037). Clinically important depression was found in 3.3 % NP women and in 1.6 % TA women. Preclinical depression was found in 13 % and 6.5 % women with NP and TA, respectively. The mean Hamilton scale score was significantly higher in NP vs. PP group (p &lt; 0.05), but was comparable with that in TA group (p &gt; 0.05). The mean score on the anxiety scale was significantly higher in TA vs. PP group (p = 0.001). Clinically significant mild to moderate anxiety was found in 4.9 % and 1.6 % TA and NP women, respectively. Mild anxiety symptoms were noted in 35.5 % of women with TA, 38.3 % of women with NP, and 15.7 % of women with PP. Multiple linear regression analysis revealed that a burdened obstetric history and the duration of the patient hospital stay had the strongest association with symptoms of depression and anxiety.Conclusion. Symptoms of prenatal anxiety and depression are widespread and should be identified in a timely manner. Psychological counseling and testing of pregnant women should be included into recommendations for pregnancy management.

ASSOCIATION BETWEEN ANXIETY AND DEPRESSION IN METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD).

This study aimed to assess the frequency and intensity of anxious and depressive symptoms in patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD). This is a descriptive and cross-sectional study, resulting from 106 patients from the Hepatology outpatient clinic at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil without a history of alcohol abuse, verified by the alcohol use disorders identification test (AUDIT). These were assessed using the sociodemographic data sheet, Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Scale (HAM-D). A total of 69.8% were women and 30.2% were men, with a mean age of 61 years. The majority (71.7%) discovered MASLD through routine exams, presenting as comorbidities: Type 2 diabetes mellitus (59.4%), Dyslipidemia (49.1%), Arterial hypertension (68.9%), Obesity (61.3%) and Metabolic syndrome [MetS (63.2%)]. The HADS scale indicates 34% probability of anxiety and 33% depressive symptoms. The Hamilton's scales of intensity indicates 63.9% severe anxiety and 54.3% severe depression. There is also a relationship between anxiety, depression and the female gender, as well as between depression and MetS. The findings point to the presence of anxiety and depression in more than one third of MASLD patients, most with severe symptoms. The group is concentrated in the elderly, with many comorbidities, including MetS. There was a positive correlation between anxiety, depression and being female; also, being significant between MetS and depression.

Evolution of Depressive Symptoms Among Depression Subtypes of Clinical and Functional Variables in Primary Care in Chile.

To compare the evolution of depressive symptoms among depressive subtypes based on clinical and functional variables in a sample of primary care in Chile. A longitudinal study was conducted in the Maule Region of Chile, focusing on 8 primary care from February 2014 to September 2015. Clinical and functional variables, including Mini International Neuro-psychiatric Interview, Outcome Questionnaire interpersonal and social sub-scales, were applied in a latent class analysis. This analysis categorized 210 patients into 3 subtypes: complex depression (N = 100), recurrent depression (n = 96), and unique depression (n = 14). Complex depression, exhibited a higher probability of suicide attempts, interpersonal and social dysfunction, and association with adverse childhood experiences according the Brief Physical and Sexual Abuse Questionnaire. Patients were monitored over 1 year with the Hamilton scale. The Kruskal-Wallis, non-parametric test, followed by paired Mann-Whitney test evaluated difference in the severity of depressive symptoms between the groups. Additionally, data on mental health interventions were collected. Out of the 210 patients, 89% were women, with a median age of 50 (range 37-58), and 40.1% with only primary education. Sociodemographic characteristics not differ between groups. Significant differences in depressive symptom severity between the groups were found (X2 90.06, P < .001, Kruskal-Wallis test, η2 = 0.084). Post hoc analyses indicated higher depressive symptoms in complex depression compared to recurrent (Z = -9.501, P < .001) and unique (Z = -2.877, P = .004) depression, with no significant difference between recurrent and unique depression (Z = -1.58, P = .113). There were no differences in the number of medical and psychological controls between the groups. The patients with complex depression required greater modifications in the pharmacological prescriptions than those belonging to the other groups. These results provide additional evidence of a complex depression subtype in primary care in Chile associated with adverse childhood experiences, that had worse resolution of depressive symptoms. Contrary to expectations, patients belonging to this group did not receive further medical and psychological interventions, probably due to a lack of specific clinical recommendations.

Efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19

To investigate the efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19. A multicenter prospective open-label study included 109 patients of both sexes aged 18 to 65 years (70 women, 39 men, average age - 41.4±13.18 years) with a leading complaint of anxiety (Hamilton scale score, HAM-A ≥18 - ≤24), which arose after acute coronavirus infections. Clinical manifestations had to meet the diagnostic criteria F43.2 ICD-10. The drug Aviander was prescribed 20 mg 2 times a day for 4 weeks. At the end of taking the drug, patients were monitored for another 1 week (a delayed follow-up visit). Psychopathological, statistical and parametric research methods were used using standardized HAM-A, Montgomery-Asberg scales (MADRS), visual analog asthenia scale (VASH-A), Sheehan Disability Scale (SDS), digital character substitution test (DSST), general clinical impression scale (CGI). Data from 109\110 patients were analyzed to evaluate efficacy\safety. Aviandr was administered 20 mg 2 times daily for 4 weeks. Patients were followed for 1 week (delayed follow-up visit) at the end of treatment. Reducing the intensity of anxiety on the HAM-A scale was - 14.2±4.92 or 69.4±22.66% by the end of treatment. The response rate to therapy (responders are patients with a decrease in the total score on the HAM-A ≥50%) was 83.49%. Remission was achieved (sum of HAM-A scores ≤7) by the end of treatment 68.81% of patients, and 79.8% of patients at the follow-up visit. Significant changes were obtained on the MADRS, VAS-A, SDS and DSST scales. According CGI 45.9% of patients had «much improved» and 43.1% of patients had «very much improved» by the end of treatment; 58.7% of patients had «much improved» and of 33.9% patients had «very much improved» at the follow-up visit. 38 adverse events were reported in 27 (24.55%) patients during the study. A definite association with study drug was reported between 5 mild adverse events in 4 (3.64%) patients. No subjects withdrew from the study due to an adverse event. Positive dynamics (reduction of anxiety symptoms, decrease in asthenia) persisted after discontinuation of the study drug. No cases of withdrawal syndrome were observed. According to the results of the study, the anxiolytic, antidepressant, antiasthenic and pro-cognitive effects of Aviandr were observed. An increase in the social activity of patients was observed.

Neuropsychiatric symptoms of post-COVID-19 condition in Mexican healthcare personnel.

Objective: The aim of the present study was to identify anxiety and depression in health personnel who suffered COVID-19, and to associate them with blood inflammatory markers. Materials and methods: The design of this study was descriptive and cross-sectional. We evaluated 51 healthcare workers who survived COVID-19 disease with Hamilton scales for anxiety and depression, also we calculated inflammatory markers (systemic immune-inflammation index, SII; monocyte lymphocyte ratio, MLR; platelet lymphocyte ratio, PLR; and neutrophil lymphocyte ratio, NLR) using blood venous samples. This study was carried out from August 2021 to December 2022. Statistical analysis was performed using SPSS v. 26. Results: Our study included 51 healthcare personnel, females (n=29) and males (n=22). The mean age was 40.54 ± 11.00 years. The most frequent acute symptoms for COVID-19 presented were dysgeusia (n=20), anosmia (n=18), and headache (n=17). The most common comorbidities were overweight (n=24), obesity (n=22), and hypertension (n=11). According to the Hamilton Rating Scale for Anxiety (HARS) and Hamilton Rating Scale for Depression Rating (HRSD) we identify anxiety and depression in 72.5% (n=37) and 51% (n=26) within the health personnel, respectively. Conclusions: In our study, we observed a high frequency of anxiety and depression in healthcare workers with post COVID-19 condition. However, we did not observe an association between inflammatory markers (NLR, PLR, MLR, and SII) with anxiety and depression in health personnel post-COVID-19. We suggest follow-up assessments in healthcare personnel with post-COVID-19 condition, to evaluate if mixed emotional disorders persist. Keywords: Anxiety; Depression; Mental disorders; Inflammation; COVID-19.

Sprouting Tree for Physiological Stress Assessment Using Fuzzy Petri Net

Background: Stressors have a huge impact on one’s well-being. They affect individual’s mental and physical health, if untreated. The response to these stresses is termed as a stress response. Based on the type and severity of the stimulus, stress can affect the various actions and functioning of the body. This explains how important it becomes to detect the level of stress and treat it well. The best treatment for stress is to identify the factors causing stress and eliminate them in the initial stage. Various methods have been proposed to detect the level of stress. One of the common methods is by using wearable devices to capture EEG signals and use various proposed algorithms to detect the level of stress. However, there are cases where stress cannot be captured by non-invasive technologies. Besides, these technologies cannot determine the stress-causing factors. This paper proposes a methodology to cater to such cases and identify the factors causing stress in the patient. It can also act as a front line methodology to detect if the candidate is suffering from anxiety or stress. The use of fuzzy logic in various healthcare areas has become very evident. This is because it deals with a range of values. While, Petri nets is a network where the arc runs from place to transition and not between places and transitions. It is the best model to use in dynamic and concurrent activities of the system. Thus, a combination of these two logics can provide an extremely competent basis for the implementation of computing reasoning processes and the modeling of systems with uncertainty. Thus, Fuzzy Petri Nets (FPN) have been proposed. This paper proposes the use of FPN in designing a methodology for factors responsible for causing stress and advancing the level of stress in the patient. The methodology is developed by observing the process of food transfer in plants. The authors have also discussed afferent and efferent stress paths. Method: The methodology proposed in this paper uses Fuzzy Petri Net. The algorithm designed in this paper has been named as the Sprouting tree algorithm by the authors. Designing the fault tree is the first and very important step for the correct determination of the level of the stress. The score generated using the Hamilton scale is fed as input to the AND/OR gate system to receive the value of stressor, and thus, drawing a fault tree. The transformation rules are applied to convert the fault tree into the FPN. Then, we derive production rules and reachability matrix. These rules help in normalizing the value obtained via fault tree so that they lie in the range of fuzzy logic. FPN calculates the certainty factor (CF), which represents the state of stress in an individual. Therefore, the values obtained from FPN will finally build a tree, which is named as Sprouting tree. Conclusions: The methodology proposed in this paper is absolutely new to detecting the stress. The future of this work is to observe the accuracy of the proposed algorithm by implementing it with real data, which is under process.

Efficacy and safety of Vespireit® (buspirone) prolonged-release tablets (PR) 15 mg in the therapy of patients with functional dizziness: results of the double-blind, placebo-controlled, multicenter, randomized, phase 3 clinical trial

Functional dizziness (FD) is one of the most common causes of chronic dizziness for which there is no effective drug therapy, highlighting the importance of searching for new treatment technologies.Objective: to evaluate the efficacy and safety of Vespireit® (INN buspirone) prolonged-release tablets 15 mg2 (JSC “Valenta Pharm”, Russia) compared with placebo in the treatment of patients with autonomic dysfunction syndrome accompanied by FD.Material and methods. The clinical trial (CT) included a total of 268 patients with autonomic dysfunction syndrome accompanied by FD and a DHI (The Dizziness Handicap Inventory) dizziness scale score of 36 to 52 inclusive, who were randomly divided into 2 groups and treated in a double-blind fashion. 135 patients (Group 1) received Vespireit® prolonged-release tablets 15 mg at a dose of 15 mg (1 tablet) once daily for 28 days. 133 patients (Group 2) received placebo at the same dosage regimen. Treatment was given against a background of vestibular gymnastic exercises. The primary outcome of the clinical trial was assessment of patient response rate (proportion of responders), i.e., a ≥50% reduction in total DHI for dizziness score at Visit 5 (day 28±1) compared with baseline (Visit 1, day 1). Secondary efficacy measures included assessment of: 1) treatment response rates (≥50% reduction in DHI total score compared to Visit 1) at Visits 2, 3, and 4; 2) DHI total score at Visits 2, 3, 4, and 5; 3) changes in DHI total score at Visits 2, 3, 4, and 5 compared to Visit 1; 4) proportion of patients with a 30% or greater reduction in DHI scale dizziness compared with baseline at Visit 2, 3, 4, and 5; 5) time elapsed until total DHI score decreased by ≥50% compared to baseline; 6) time elapsed until total DHI score decreased by ≥30% compared to baseline; 7) changes in Digital Rating Scale (DRS) score from Visit 1 to Visit 2, 3, 4, 5; 8) scores on the DRS at Visits 2, 3, 4, 5; 9) proportion of patients with different response to treatment on the Likert scale at Visits 2, 3, 4, and 5. Additional secondary criteria of efficacy were also assessed: total Hamilton Depression Rating Scale (HDRS) score at Visits 4 and 5; change in total Hamilton scale score at Visits 4 and 5 compared to Visit 1. The safety criterion assessed in the clinical trial was monitoring of adverse events (AEs), clinically significant deviations in vital signs, laboratory parameters, and ECG parameters.Results. The proportion of responders with a ≥50% reduction in DHI total score at Visit 5 (Day 28±1) compared to baseline (Visit 1, Day 1) was 68.7% (n=92) in Group 1, which was 52.9% more than in Group 2 – 15.8% (n=21) (p&lt;0.0001). Evaluation of all secondary (including additional) efficacy criteria also showed a statistically significant benefit of therapy in Group 1 compared to Group 2 (p&lt;0.0001). A total of 61 AEs were recorded in 46 (17.2%) patients: 30 AEs in 21 (15.6%) patients in Group 1 and 31 AEs in 25 (18.8%) patients in Group 2. There was no significant difference between treatment groups in the number of patients with AEs (p=0.5196). In both groups, there were no patients with AEs with severity ≥3, serious AEs (SAEs), SAEs with fatal outcome, or SAEs that led to discontinuation of study therapy. No clinically significant abnormalities were noted during assessment of vital signs, laboratory parameters, or ECG parametersConclusion. The superiority of Vespireit® prolonged-release tablets (PR) 15 mg therapy over placebo in reducing FD in patients with autonomic dysfunction syndrome was confirmed. The drug demonstrated a favorable safety profile comparable to placebo.